A Case of Hemolytic Anemia Caused by Felt Strips in the Proximal Anastomosis Site after Acute Aortic Dissection Surgery

Abstract

The patient was a 49-year-old male who had undergone total arch replacement with Elephant trunk procedure for acute aortic dissection Stanford type A at another institution. Eight months post-surgery, he presented with hematuria and jaundice. Mechanical hemolysis by grafts was considered, and he was referred to our hospital. Subsequently, we conducted transesophageal echocardiography, which revealed the inversion of felt strips at the proximal anastomosis site, accompanied by blood turbulence at the same site. Consequently, we established a diagnosis of mechanical hemolysis attributed to the inversion of the inner felt strip within the anastomosis, prompting a redo surgery. The utilization of felt strips for reinforcing the anastomosis has become a prevalent technique in ascending aortic replacement for acute aortic dissection. This technique serves to mitigate hemorrhage from the anastomosis and counteract the formation of pseudoaneurysms. In this study, we report an uncommon complication caused by the presence of felt strips within the anastomosis.